Healthcare Provider Details

I. General information

NPI: 1659248821
Provider Name (Legal Business Name): WILDER ACADEMY OF VIRTUAL EDUCATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2025
Last Update Date: 11/06/2025
Certification Date: 11/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 HUFF RD
WILDER ID
83676-5003
US

IV. Provider business mailing address

419 HUFF RD
WILDER ID
83676-5003
US

V. Phone/Fax

Practice location:
  • Phone: 203-337-7400
  • Fax:
Mailing address:
  • Phone: 203-337-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: AMY GRAUBERGER
Title or Position: SPED DIRECTOR / VICE PRINCIPAL
Credential: EDS,MA
Phone: 986-256-7220